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Anterior advancement of the tibial tuberosity in the treatment of the patellofemoral pain syndrome

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Seventy-two patients with disabling patellofemoral pain were treated with anterior advancement of the tibial tuberosity. In a follow-up examination 1–5 years (mean 2.5) postoperatively, 57% of the patients had improved, 19% were unchanged, and 24% were worse. The high failure rate is disturbing, and we warn against too frequent use of the anterior tuberosity advancement procedure. Patients with patellofemoral pain should be approached by establishing a specific diagnosis and applying a specific treatment. In this study we concluded that the only patients who might benefit from the operation were those with grade I-11 changes of the patellar cartilage.


Bei 72 Patienten mit krankmachenden Schmerzen im Femoropatellargelenk wurde eine operative Ventralverlagerung der Tuberositas tibiae vorgenommen. Bei einer Nachuntersuchung 1–5 Jahre (durchschnittlich 2,5 Jahre) nach der Operation war bei 57% der Patienten eine Besserung zu verzeichnen. Bei 19% war keine Änderung and bei 24% eine Verschlimmerung eingetreten. Die hohe Rate der Mißerfolge hat zu einer Verunsicherung geführt, and als Schlußfolgerung daraus wird vor einer allzu häufigen Anwendung dieser Operation gewarnt. Patienten mit femoropatellaren Schmerzen sollten einer spezifischen Diagnostik and Therapie zugeführt werden. Die einzigen Patienten in dieser Studie, die möglicherweise von dieser Operation einen Nutzen gehabt haben, waren jene mit einem Knorpelschaden Grad I–II an der Kniescheibe.

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  1. 1.

    Abernethy PJ, Townsend PR, Rose RM, Radin EL (1978) Is chondromalacia patellae a separate clinical entity? J Bone Joint Surg [Br] 60:205–210

  2. 2.

    Bandi W (1976) Vorverlagerung der Tuberositas tibiae bei Chondromalacia patellae and femoro-patellarer Arthrose. Hefte Unfallheilkd 127:175

  3. 3.

    Bandi W (1977) Zur operativen Therapie der Chondromalacia patellae. Zentralbl Chir 102:1297–1301

  4. 4.

    Bandi W, Brenwald J (1974) The significance of femoropatellar pressure in pathogenesis and treatment of chondromalacia patellae and femoropatellar arthrosis. In: The knee joint 63. Elsevier, New York

  5. 5.

    Bennett GA, Waine H, Bauer W (1942) Changes in the knee joint at various ages, with particular reference to the nature and development of degenerative joint diseases. Commonwealth Fund, New York

  6. 6.

    Bentley G (1978) The surgical treatment of chondromalacia patellae. J Bone Joint Surg [Br] 60:74–81

  7. 7.

    Björkström S, Goldie IF, Wettervist H (1980) Intramedullary pressure of the patella in chondromalacia patellae. Arch Orthop Trauma Surg 97:81–85

  8. 8.

    Cox JS (1982) Evaluation of Roux-Emslie-Trillat procedure for knee extensor realignment. Am J Sports Med 10:303–310

  9. 9.

    Ferguson AB, Brown TD, Fu FH, Rutkowski R (1979) Relief of patello-femoral contact stress by anterior displacement of the tibial tubercle. J Bone Joint Surg [Am] 61:159–166

  10. 10.

    Ferguson AB (1982) Elevation of the insertion of the patellar ligament for patello-femoral pain. J Bone Joint Surg [Am] 64:766–771

  11. 11.

    Ficat P, Ficat C, Bailleux A (1975) Syndrome d'hyperpression externe de la rotule. Rev Chir Orthop 61:39–59

  12. 12.

    Harwin SF, Stern RE (1981) Subcutaneous lateral retinacular release for chondromalacia patellae. Clin Orthop 156:207–210

  13. 13.

    DeHaven KE, Collins HR (1975) Diagnosis of internal derangements of the knee. The role of arthroscopy. J Bone Joint Surg [Am] 57:802–810

  14. 14.

    Hejgaard N, Watt-Boolsen S (1982) The effect of anterior displacement of the tibia] tuberosity in idiopathic chondromalacia patellae. Acta Orthop Scand 53:135–139

  15. 15.

    Hirsh DM, Reddy DK (1980) Experience with Maquet anterior tibial tubercle advancement for patello-femoral arthralgia. Clin Orthop 148:136–139

  16. 16.

    Insall J, Tria AJ, Aglietti P (1980) Resurfacing of the patella. J Bone Joint Surg [Am] 62:933–936

  17. 17.

    Insall J (1982) Patellar pain. J Bone Joint Surg [Am] 64:147–152

  18. 18.

    Johnson LL, Drez D Jr, Ewing JW, Jackson RW, McGinty J (1980) Arthroscopic technique in diagnosis and surgery. Contemp Orthop 2:459–483

  19. 19.

    Karlsson J, Lansinger O, Romanus B, Svärd L (to be published) Lowering of the patella after anterior advancement of the tibial tubercle

  20. 20.

    Larson RL, Cabaud HE, Slocum DB, James SL, Keenan T, Hutchinson T (1978) The patellar compression syndrome: surgical treatment by lateral retinacular release. Clin Orthop 134:158–167

  21. 21.

    Leslie IJ, Bentley G (1978) Arthroscopy in the diagnosis of chondromalacia patellae. Ann Rheumatol Dis 37:540–547

  22. 22.

    Lund F, Nilsson BE (1980) Anterior displacement of the tibial tuberosity in chondromalacia patellae. Acta Orthop Scand 51:679–688

  23. 23.

    Maquet P (1963) Un treaement biomecanique de l'arthrose femoropatellaire. L'avancement du tendon rotulien. Rev Rhum 30:779–783

  24. 24.

    Maquet P (1976) Advancement of the tibial tuberosity. Clin Orthop 115:225–230

  25. 25.

    Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg [Br] 43:752–757

  26. 26.

    Pridie KH (1959) A method of resurfacing osteoarthritic knee-joints. J Bone Joint Surg [Br] 41:618–619

  27. 27.

    Radin EL (1979) A rational approach to the treatment of patellofemoral pain. Clin Orthop 144:107–109

  28. 28.

    Rozbruch JD, Campbell RD, Insall J (1979) Tibial tubercle elevation: a clinical study of thirty-one cases. Orthop Trans 3:291–292

  29. 29.

    Sudman E, Salkowitsch B (1980) Anterior displacement of the tibial tuberosity in the treatment of chondromalacia patellae. Acta Orthop Scand 51:171–174

  30. 30.

    Slocum DB, James SL, Larson RL (1973) Surgical treatment of the dislocating patellae in athletes. J Bone Joint Surg [Am] 55:1770

  31. 31.

    Waisbrod H, Treiman N (1980) Anterior displacement of tibial tuberosity for patello-femoral disorders. Clin Orthop 153:180–182

  32. 32.

    Wiles P, Andrew PS, Bremner RA (1960) Chondromalacia of the patella. A study of the later results of excision of the articular cartilage. J Bone Joint Surg [Br] 42:65–70

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Correspondence to J. Karlsson.

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Karlsson, J., Lansinger, O. & Sward, L. Anterior advancement of the tibial tuberosity in the treatment of the patellofemoral pain syndrome. Arch. Orth. Traum. Surg. 103, 392–395 (1985). https://doi.org/10.1007/BF00435447

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  • Public Health
  • Failure Rate
  • Specific Treatment
  • Pain Syndrome
  • Specific Diagnosis